LCL Tear

Overview

The lateral collateral ligament (LCL) is a thin band of connective tissue that runs along the outside of the knee. It connects the femur (thighbone) to the fibula (the more slender long bone of the calf). Similar to the medial collateral ligament (at the inside of the knee), the LCL works to stabilize the knee as it moves. LCL tears commonly result when a direct blow to the inside of the knee stretches the outer ligament until it tears. The tear may occur anywhere along the ligament – in the middle or at either end.

People often tear the LCL while playing a sport in which forceful collisions are common, such as football or hockey. The LCL and posterolateral corner (back and outside part of the knee) may also be injured in a car accident, fall or another event that impacts the area. It's important to know that an LCL tear usually occurs in conjunction with another knee injury.

Our approach to LCL tears

UCSF is committed to helping patients with LCL tears return to their highest possible level of activity, whether that means a daily walk or reporting for practice with the NFL. Our team includes orthopedic surgeons, primary care sports medicine doctors, physical therapists and athletic trainers. These specialists work together to tailor a treatment plan to each patient's needs and goals.

Signs & symptoms

The most common symptoms of an LCL tear are pain, stiffness, swelling and tenderness along the outer side of the knee. Your knee may also feel loose, as though it will give way under stress. More severe tears can cause numbness or weakness in the foot; this occurs if the peroneal nerve (located near the LCL) is stretched at the time of injury or squeezed by subsequent swelling of the surrounding tissues.

Diagnosis

The first step is a physical exam. Your doctor will check the outside of the knee for pain or tenderness, then apply pressure to the area while your leg is both bent and straight, which can indicate the severity of your injury.

Sometimes the immediate pain and swelling make it difficult to gauge severity. In this case, you may be asked to wear a light brace and to ice and elevate your knee until the swelling goes down.

Your doctor may also order the following tests:

• X-rays. These can reveal a fracture of the fibula or other bones, such as the femur and tibia (larger long bone of the calf).
• Magnetic resonance imaging (MRI). This test assesses the severity of LCL injuries with more than 90 percent accuracy. It's often used to confirm the ligament injury diagnosis and to check for injuries to cartilage or other knee ligaments.

Treatments

Treatment depends on the extent of injury. Severe LCL tears, which often happen along with other knee damage, may require surgery, followed by physical therapy. Less severe injuries usually respond to physical therapy alone. We offer the full range of physical therapies, including exercise regimens, functional activities and neuromuscular reeducation (techniques that train the area to move normally again). Our specialists guide each patient through a personalized program designed to facilitate healing, recover function and improve physical performance.

Although severe injuries often require surgery, lesser damage usually responds well to nonsurgical treatment. Recovery time depends on the injury's severity.

Rehabilitation for an LCL tear consists of:

• A period of rest
• Bracing
• Physical therapy

Once pain and swelling have subsided, you should be able to begin exercises to restore strength and normal range of motion.

If your torn LCL doesn't heal sufficiently, you may experience instability in the joint, making it susceptible to reinjury. Surgery to treat a torn LCL usually calls for general anesthesia and takes one to two hours, though it may take longer if other knee injuries – such as a tear of the anterior cruciate ligament – also require surgical treatment. The surgeon makes an incision on the outside of the knee to gain access to the torn ligament. In some cases, the ligament is reattached to the bone with sutures, screws or other devices. In other cases, the ligament is reconstructed with a tendon from either the patient's other knee or a cadaver knee.

After surgery, patients work closely with a physical therapist on regaining motion and strength. One to two weeks after surgery, you'll see the doctor again for a physical exam, removal of sutures and X-rays. You'll generally be using crutches and a knee brace for six weeks after surgery. Rehabilitation plans vary according to the specific injury and surgical procedure, though a full return to sports is generally achieved nine to 12 months after surgery.